TY - JOUR
T1 - Hospital complications among older adults
T2 - Better processes could reduce the risk of delirium
AU - Moura Junior, Valdery
AU - Westover, M. Brandon
AU - Li, Feng
AU - Kimchi, Eyal
AU - Kennedy, Maura
AU - Benson, Nicole M.
AU - Moura, Lidia Maria
AU - Hsu, John
N1 - Publisher Copyright:
© The Author(s) 2021.
PY - 2022/8
Y1 - 2022/8
N2 - Using observational data and variation in hospital admissions across days of the week, we examined the association between ED boarding time and development of delirium within 72 hours of admission among patients aged 65+ years admitted to an inpatient neurology ward. We exploited a natural experiment created by potentially exogenous variation in boarding time across days of the week because of competition for the neurology floor beds. Using proportional hazard models adjusting for socio-demographic and clinical characteristics in a propensity score, we examined the time to delirium onset among 858 patients: 2/3 were admitted for stroke, with the remaining admitted for another acute neurologic event. Among all patients, 81.2% had at least one delirium risk factor in addition to age. All eligible patients received delirium prevention protocols upon admission to the floor and received at least one delirium screening event. While the clinical and social-demographic characteristics of admitted patients were comparable across days of the week, patients with ED arrival on Sunday or Tuesday were more likely to have had delayed floor admission (waiting time greater than 13 hours) and delirium (adjusted HR = 1.54, 95%CI:1.37–1.75). Delayed initiation of delirium prevention protocol appeared to be associated with greater risk of delirium within the initial 72 hours of a hospital admission.
AB - Using observational data and variation in hospital admissions across days of the week, we examined the association between ED boarding time and development of delirium within 72 hours of admission among patients aged 65+ years admitted to an inpatient neurology ward. We exploited a natural experiment created by potentially exogenous variation in boarding time across days of the week because of competition for the neurology floor beds. Using proportional hazard models adjusting for socio-demographic and clinical characteristics in a propensity score, we examined the time to delirium onset among 858 patients: 2/3 were admitted for stroke, with the remaining admitted for another acute neurologic event. Among all patients, 81.2% had at least one delirium risk factor in addition to age. All eligible patients received delirium prevention protocols upon admission to the floor and received at least one delirium screening event. While the clinical and social-demographic characteristics of admitted patients were comparable across days of the week, patients with ED arrival on Sunday or Tuesday were more likely to have had delayed floor admission (waiting time greater than 13 hours) and delirium (adjusted HR = 1.54, 95%CI:1.37–1.75). Delayed initiation of delirium prevention protocol appeared to be associated with greater risk of delirium within the initial 72 hours of a hospital admission.
KW - access/demand/utilization of services
KW - aging
KW - clinical practice patterns
KW - geriatrics
KW - health care organizations and systems
KW - hospitals
KW - integrated delivery systems
KW - mental health
KW - quality of care/patient safety
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U2 - 10.1177/09514848211028707
DO - 10.1177/09514848211028707
M3 - Article
C2 - 34247525
AN - SCOPUS:85110060355
SN - 0951-4848
VL - 35
SP - 154
EP - 163
JO - Health Services Management Research
JF - Health Services Management Research
IS - 3
ER -